refund form / formulario de devolución

REFUND FORM / FORMULARIO DE DEVOLUCIÓN
TO BE COMPLETED BY CANDIDATE (IN CAPITAL LETTERS) / DATOS A RELLENAR POR EL CANDIDATO (EN MAYÚSCULAS)
COUNTRY
CENTRE
SPAIN
CANDIDATE NAME / NOMBRE Y APELLIDOS DEL CANDIDATO
REF NUMBER / Nº REFERENCIA
METHOD OF PAYMENT / MÉTODO DE PAGO
LAST 4 DIGIT OF THE CARD NUMBER (same card you made the
payment with) / ÚLTIMOS 4 DÍGITOS DE LA TARJETA (sólo para pagos
con tarjeta, tiene que ser la misma tarjeta que usó para realizar el
pago original)
BANK TRANSFER (ACCOUNT HOLDER NAME & ACCOUNT NUMBER
(Only for bank transfers, same account number you transfer the
money from) / TRANSFERENCIA BANCARIA (TITULAR DE LA CUENTA Y
NÚMERO DE CUENTA) (Sólo para transferencias bancarias, debe ser el
mismo número de cuenta desde el que se realizó la transferencia)
DATE OF INITIAL TRANSACTION (DD. MM. YYYY) / FECHA DE PAGO
(DD.MM.AAAA)
Titular de la cuenta
/ Account Holder
IBAN
SWIFT / BIC
CURRENCY OF INITIAL TRANSACTION / MONEDA DE TRANSACCIÓN
ACTUAL AMOUNT OF TRANSACTION / IMPORTE ABONADO
REASON FOR REFUND / MOTIVO DE LA DEVOLUCIÓN
CANDIDATE EMAIL ID (for confirmation of refund) / EMAIL DEL
CANDIDATO (para confirmación de la devolución)
TO BE COMPLETED BY EXAMS DEPARTMENT (IN CAPITAL LETTERS) / DATOS A RELLENAR POR EL DPTO. DE EXÁMENES
Tick the relevant option
ORS
REX
AMOUNT OF REFUND
REFUND UPDATED ON ORS/REX PORTAL (Yes / No )
Please tick if the refund amount is same as actual Transaction. If not, please provide the reason in the below space
FOR COUNTRY ONLY
Prepared by:
DESIGNATION
NAME
SIGN
Approved by:
Date of Approval:
** I declare that I am approving this Refund request within limits of my Delegated Authority and all documents have been verified before requesting the refund
Bank Transfer: WBS:
GL:
FOR SSC ONLY
Refund Ref. No. :
_____________
NAME
Refund Processed By:
Audited By:
Refund Processing Date:
SIGN
REFUND FORM / DIRU ITZULTZERAKO INPRIMAKIA
TO BE COMPLETED BY CANDIDATE (IN CAPITAL LETTERS) HAUTAGAIAK BETE BEHARREKO DATUAK (MAISKULAZ BETE)
COUNTRY/ ESTATUA
CENTRE/
ZENTROA
SPAIN
CANDIDATE NAME/ HAUTAGAIAREN IZEN ABIZENAK
REF NUMBER / ERREFERENTZIA ZENBAKIA
METHOD OF PAYMENT / ORDAINKETA MODUA
LAST 4 DIGIT OF THE CARD NUMBER (same card you made the
payment with) / TXARTELAREN AZKEN LAU DIGITUAK (Soilik
txartelarekin egindako ordainketetarako.Ordainketa egiteko erabili
den txartel berak izan behar du)
BANK TRANSFER (ACCOUNT HOLDER NAME & ACCOUNT NUMBER
(Only for bank transfers, same account number you transfer the
money from) /BANKU-TRANSFERENTZIA (KONTUAREN JABEA ETA
KONTU KORRONTEAREN ZENBAKIA (Soilik banku transferentziaren
bidez egindako ordainketetarako. Ordainketa erabili den kontu
zenbaki berak izan behar du)
DATE OF INITIAL TRANSACTION (DD. MM. YYYY) / ORDAINKETAREN
DATA (EE.HH.UUUU)
CURRENCY OF INITIAL TRANSACTION / TRANSAKZIOAN ERABILI DEN
MONETA
Kontuaren Jabea/
Account Holder
IBAN
SWIFT / BIC
ACTUAL AMOUNT OF TRANSACTION / ORDAINDUTAKO ZENBATEKOA
REASON FOR REFUND ITZULTZEAREN ARRAZOIA
CANDIDATE EMAIL ID (for confirmation of refund) / HAUTAGAIAREN
EMAILA (itzultzea baieztatzeko)
TO BE COMPLETED BY EXAMS DEPARTMENT (IN CAPITAL LETTERS) / AZTERKETA SAILAK BETEBEHARREKOA
Tick the relevant option
ORS
REX
AMOUNT OF REFUND
REFUND UPDATED ON ORS/REX PORTAL (Yes / No )
Please tick if the refund amount is same as actual Transaction. If not, please provide the reason in the below space
FOR COUNTRY ONLY
Prepared by:
DESIGNATION
NAME
SIGN
Approved by:
Date of Approval:
** I declare that I am approving this Refund request within limits of my Delegated Authority and all documents have been verified before requesting the refund
Bank Transfer: WBS:
GL:
FOR SSC ONLY
Refund Ref. No. :
_____________
NAME
Refund Processed By:
Audited By:
Refund Processing Date:
SIGN